When teachers and other school staff in West Virginia walked off the job in 2018, news coverage of the historic strike focused on bread-and-butter issues like their rising health-care premiums and low wages. There were horror stories of teachers working extra jobs and struggling to pay for emergency medical costs. But there were other galvanizing factors that, though less discussed, were no less galling—indignities that have become increasingly familiar to workers across the country.
As Brandon Wolford, a teacher from Mingo County, West Virginia, told a packed room at the LaborNotes conference in Chicago last year, he and his coworkers were moved to action when they were required to either pay a fee or participate in a workplace wellness program called “Healthy Tomorrows,” which penalized members for not scoring “acceptable” on a series of biometric measures. “The next thing you know we get a paper in the mail,” he said. “It says you have to go to the doctor by such and such a date. Your blood glucose levels must be at certain amounts, your waist size must be at certain amounts, and if it is not, you don’t meet all these stipulations, then you get a $500 penalty on your out-of-pocket deductible.”
But, Wolford said, it was a subsequent wellness program that really “awoke the sleeping giant.” In 2018, the West Virginia Public Employee Insurance Agency (PEIA), the board that determines health insurance plans for all West Virginia public employees, announced that, in addition to hiking premiums, it was enrolling everyone in a program from Humana, a for-profit insurance company, called Go365. This initiative required workers to participate in screenings and earn wellness points through a variety of activities to avoid incurring fees. Employees could receive points for wearing a Fitbit and tracking their steps or keeping their body mass index (BMI) below a designated threshold. According to Wolford, it also “included private questions such as: How much sexual activity do you perform in a week? Is it vigorous?” Anyone who refused to participate was charged an additional $25 per month—up to a $300 yearly burden for workers who were often making less than $47,000 annually, the fifth-lowest salary rate for teachers in the country.
Go365 was discontinued in the aftermath of the strike. But the scourge of worker wellness programs elsewhere continues unabated, for private- and public-sector workers alike.
A 2018 survey by the Kaiser Foundation found that 82 percent of large companies (those with more than 200 employees) and 53 percent of small companies have an option for some kind of wellness program. Some, like Go365, are obviously punitive, levying up to thousands of dollars in fines on workers who refuse to participate in wellness campaigns or fail to meet certain biometric measures of health. Others have more nebulous “incentives”—a gift card, say, or a discount on gym membership. The line between punishment and incentive, however, is thin. If a worker gets a gym reimbursement for working out six times a month, doesn’t that translate to a material punishment for those with physical disabilities, those who are overworked, and those who simply would prefer not to?
Though management typically peddles wellness programs to workers as generous perks, they are actually a way for employers to save money. The Affordable Care Act (ACA) allows employers to “incentivize” participation in wellness programs; the savings come through guidelines that, until recently, allowed employers to tie 30 percent of premiums for individuals and 50 percent for smokers to participation in those programs. This effectively amounts to a fine, sometimes thousands of dollars steep, for those who don’t participate.
It’s a prime example of the ways that the ACA, though lauded as a breakthrough in equitable universal health coverage, reinforces the notion that your employer should be responsible for your health, thereby making employee health a business expense. The rise of the worker wellness program, along with the visceral backlash to it, has revealed the limits and small humiliations of this neoliberal approach to health care. It offers, in implicit contrast, an argument for a more humane strengthening of the social safety net—while demanding a collective worker-based response to the various ways employers affect our daily well-being.
Even before the ACA, employers were coming to adopt the notion that worker wellness programs could save them money. According to a 2009 report, the return on investment at a transportation authority in Austin, Texas, was $2.43 for every dollar spent on employee wellness. The study arrived at this figure via a rather imprecise formula that took into account absenteeism and health-care costs—two factors that were supposed to help quantify worker productivity.
Employee productivity has long been something of an obsessive focus for corporations. According to a 2015 study, “Relatively common conditions such as hypertension, heart disease, and depression are estimated to cost $392, $368, and $348, respectively, per employee per year owing to productivity loss.”
The language of productivity is everywhere, and even is applied when the workplaces themselves are causing health-related issues. For example, a 2017 report from the Northeast Business Group on Health found that “the prevalence of workplace-generated [musculoskeletal disorders] is increasing” due especially to millennials’ use of “technology” (meaning neck and back strain from looking at devices for long hours) and “working remotely” (leading to workers being more sedentary throughout the day). The report went on to recommend that “preventative programs can have a significant impact on workplace health and productivity as well as an organization’s bottom line.” This prevention regime, however, involves educating employees about the RICE system (rest, ice, compression, and elevation) for treating injuries or buying a bundled insurance package for hip and knee replacements. The report notably did not call for corporations to provide employees with additional breaks or a better work-life balance overall.
Productivity is precisely the kind of concept that enters the arena of health care when employers are the primary providers of that care. In the productivity mindset, good health is not good for the well-being of a person but only insofar as it serves the employer’s interests. And in this mindset, the cost of a worker’s impaired health is just one more expense for employers to cut.
But recent research suggests that wellness programs aren’t even accomplishing the goals of promoting health or increasing productivity. In a large-scale study, 33,000 employees at BJ’s Wholesale Club were randomly assigned to be in a group taking part in the BJ’s wellness plan or a control group that was not. The study, published in JAMA in April, found that while workers showed a bump in a few self-reported health activities, there were no significant changes in clinical measures of health, absenteeism, or work performance—all supposed money-savers for employers.
And how are these programs measuring health, anyway? Unfortunately, the concept of “health” is nearly as nebulous and difficult to measure as “productivity.” In the BJ’s study, people on these programs didn’t lower their BMI, cholesterol, or blood glucose levels enough to amount to any significant difference from the control group. But even those supposed markers of health are hardly neutral—the idea that weight loss, for example, is inherently healthy is unscientific at best, and fat-phobic and dangerous at worst. Many of the biometric measures employed in wellness plans present similar difficulties—for example, the West Virginia program listed an “acceptable” level of total cholesterol, while the Centers for Disease Control and Prevention now distinguishes between “good” and “bad” types of cholesterol.
More broadly, simple numbers can’t capture everything necessary to be a healthy person. An obsessive focus on those metrics can even harm workers who have disabilities or eating disorders, or who just don’t want to think about their bodies on the job.
Indeed, there is research showing the negative impact of worker wellness programs. In a 2015 paper titled “Employers Should Disband Employee Weight Control Programs,” the American Journal of Managed Care said such programs could bring down company morale and might be bad for employee health. The authors raised concerns that wellness campaigns could encourage crash dieting, humiliating of bigger employees, and overdiagnosis from over-screening.
The AJMC study also warned that employees might begin to “resent corporate intrusion”—but corporate intrusion into employee health is, unfortunately, becoming the norm at work, even without the blunt instrument of a company-sponsored wellness plan.
Employees from various workplaces told me about Biggest Loser–style competitions in their offices, initiated both top-down from human resources and by employees themselves amid an atmosphere that prized weight loss, pitting workers against one another to see who could lose the most weight. An employee who worked in public relations told me about a corporate program where pounds lost were directly compensated with dollars. A social worker told me about a “stress and nutrition” seminar at work that opened with a presentation from human resources on the importance of dieting. Even the most seemingly benign perk, like free healthy lunches, can be subtly invasive—not only enabling employers to watch what employees eat, but also reinforcing the boss’s mandate to keep an eye on them generally.
That prospect may sound faintly paranoid, but employers are increasingly watching workers, with more tools than ever at their disposal. There are obvious extremes, like the Wisconsin company implanting microchips in their employees, supposedly for sign-in purposes, or Amazon’s automated tracking and firing systems, which can monitor and discipline employees without the intercession of a human being. Likewise, wellness “perks” can also provide opportunities for surveillance. In April, reports emerged that a fertility tracking app, Ovia, was sending personal data on workers to employers, including, according to The Washington Post, aggregated data on high-risk births and return-to-work times, as well as specific information about workers’ internet search history (topics included filing for disability, dealing with pain, and having sex while pregnant).
And in 2017, House Republicans introduced a bill called the “Preserving Employee Wellness Programs Act” that would have removed some privacy protections for employees who opt to share medical information through a workplace wellness program. The bill has been stalled in committee deliberations, but it nonetheless represents the emerging consensus on the suitability of maximum employer surveillance in matters of workplace health.
An app sending data to employers about your period and a machine firing you from your Amazon warehouse job may seem far apart in terms of intrusive workplace surveillance. But they exist on the same basic Orwellian continuum, extending corporate control ever further into the private lives of workers.
In addition to being invasive and ineffective, worker wellness programs are often discriminatory, particularly toward disabled people. In a series of lawsuits from 2014 to 2016, the Equal Employment Opportunity Commission charged companies with unfairly punishing employees for not participating in these programs or screenings, thereby violating the Americans with Disabilities Act, which says that employers cannot require medical examinations unless they are “job-related.”
The EEOC has largely failed to convince courts of its argument. Meanwhile, the agency’s own guidelines governing wellness programs have drawn court challenges from the American Association of Retired Persons (AARP), among other advocacy groups. The AARP scored a major victory when, in 2017, a court ruled that the EEOC guidelines let employers penalize workers to much for non-participation in wellness programs. As of January, the ACA’s allowance of tying up to 30 percent of premiums to participation has been vacated. Now, says Dara Smith, senior attorney at the AARP Foundation, many are confused about what regulations still apply, with some thinking that “there’s just no law.” She added, “We’re in the Wild West,” in terms of regulations of worker wellness programs.
The AARP continues to challenge wellness programs in court. In July, AARP lawyers filed a class action lawsuit on behalf of Yale employees, who faced fines of more than $1,000 for not disclosing private medical information as part of a wellness program.
But a workplace-by-workplace lawsuit approach, slow and susceptible to setbacks and reversals, won’t stem the rising tide of wellness programs. So what will?
One blunt approach would be to eliminate employer-sponsored insurance entirely. Wellness programs are the logical conclusion of a system that, instead of treating health care as a basic human right, funnels issues of health and well-being into a narrow, unforgiving econometric rubric. Health care in this country would be simpler and more humane if employers were simply removed from the equation.
Indeed, the argument against a single-payer system, which stresses the importance of “choice” in health care, ignores a distressing reality: When it comes to health care, employees are at the mercy of their employers, which are usually making decisions based on cost, not what is best for employee health. Workers also sometimes remain in workplaces that are actively harming their health, whether through stress or long hours, just to maintain access to sub-par health insurance coverage. A national effort to remove those pressures is a vital step.
But even with a Medicare-for-All system, employers will still wield a massive—and often negative—influence over their employees’ health, through low pay, long hours, few breaks, and little time off. These trends have become endemic to the American workplace, where the 40-hour work week is all but defunct in most workplaces. Many workers can’t live on one job alone, while employers seem to routinely expect workers to be available at all times—whether it’s the Amazon fulfillment center that runs employees to the ground, or offices that expect a constant presence on phone and email.
To address the sort of everyday issues that can lead to bad health, workers might look to the West Virginia teacher strikes for motivation. Nicole McCormick is a teacher in Mercer County, West Virginia, and the president of her local union. She says that once her colleagues saw that their health activities were being tracked, they were strongly motivated to join together and, eventually, strike, saying, “We’re not trained dogs that you can click a dog clicker at and give us a treat and we’ll roll over and do what you want.” When it comes to health and safety, unions speak often of focusing on the hazard, not the worker: eliminate the hazard (say, by providing ergonomic office equipment) and the potential harm (repetitive stress injury) goes away. Through organizing, workers can force their employers to make changes at work that will help them stay healthy.
What the union effort also shows is that health care is a holistic issue. Even if we were to eliminate the scourge of degrading and ineffective workplace wellness programs, we would still need to address, either through collective effort or government reform, all the ways in which employers affect our health. When it comes to health care, we are not just talking about insurance coverage—we are also, by definition, agitating for a living wage; a reasonable balance between work and life; a more humane world.